Colposcopy and Cervical Biopsy

Test Overview

Colposcopy is a way for your doctor to use a special
magnifying device to look at your
vulva,
vagina, and
cervix. If a problem is seen during colposcopy, a
small sample of tissue (biopsy) may be taken from the cervix or
from inside the opening of the cervix (endocervical canal). The sample is
looked at under a microscope.

Colposcopy is usually done to look at the vagina and cervix when the result of a
Pap test is abnormal. Most abnormal Pap tests are
caused by viral infections, such as
human papillomavirus (HPV) infection, or other types
of infection, such as those caused by bacteria, fungi (yeast), or protozoa
(Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to
menopause can also cause an abnormal Pap test. In some
cases, untreated cervical cell changes that cause abnormal Pap tests may
progress to precancerous or cancerous changes.

During colposcopy, your doctor uses a lighted magnifying device
that looks like a pair of binoculars (colposcope). The colposcope allows your
doctor to see problems that would be missed by the naked eye. A camera can be
attached to the colposcope to take pictures or videos of the vagina and
cervix.

Your doctor may put vinegar (acetic acid) and sometimes iodine
(Lugol's solution) on the vagina and cervix with a cotton swab or cotton balls
to see problem areas more clearly.

Why It Is Done

Colposcopy is done to:

Look at the cervix for problem areas when a Pap
test was abnormal. If an area of abnormal tissue is found during colposcopy, a
cervical biopsy or a biopsy from inside the opening of the cervix (endocervical
canal) is usually done.

Check a sore or other problem (such as
genital warts) found on or around the vagina and
cervix.

Follow up on abnormal areas seen on a previous colposcopy.
Colposcopy can also be done to see if treatment for a problem
worked.

Look at the cervix for problem areas if an HPV test shows a
high-risk type of HPV is present.

How To Prepare

Tell your doctor if you:

Are or might be pregnant. A blood or urine test
may be done before the colposcopy to see whether you are pregnant. Colposcopy
is safe during pregnancy. If a cervical biopsy is needed during a colposcopy,
the chance of any harm to the pregnancy (such as
miscarriage) is very small. But you may have more
bleeding from the biopsy. A colposcopy may be repeated about 6 weeks after
delivery.

Are taking any medicines.

Are allergic to
any medicines.

Have had bleeding problems or take blood thinners, such
as aspirin or warfarin (such as Coumadin).

Have been treated for a vaginal,
cervical, or pelvic infection.

Do not have sexual intercourse or put anything into your vagina for 24 hours before a colposcopy. This includes douches, tampons, and vaginal medicines. You will empty your bladder just before your colposcopy.

You may want to take a pain reliever, such as ibuprofen (Advil or
Motrin), 30 to 60 minutes before having a colposcopy, especially if a biopsy
may be done. This can help decrease any cramping pain that can be caused by the
colposcopy.

Schedule your colposcopy for when you are not having your period. Heavy bleeding makes it harder for your doctor to see your cervix. The best
time to schedule a colposcopy is during the early part of your
menstrual cycle, 8 to 12 days after the start of your
last menstrual period.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor
about any concerns you have regarding the need for the colposcopy, its risks,
how it will be done, or what the results will mean. To help you understand the
importance of this test, fill out the
medical test information form(What is a PDF document?).

You will need to take off your clothes below the waist. You will be
given a covering to drape around your waist. You will then lie on your back on
an examination table with your feet raised and supported by foot rests
(stirrups).

The doctor will insert a lubricated tool called a speculum into your vagina. The speculum gently spreads apart the vaginal
walls so your doctor can see inside the vagina and the cervix.

The colposcope is moved near your vagina, and your doctor looks
through the microscope at the vagina and cervix. Vinegar (acetic acid) or
iodine (Lugol's solution) may be used on your cervix to make abnormal areas
more visible. Photographs or videos of the vagina and cervix may be
taken.

If areas of abnormal tissue are found on the cervix, your doctor
will take a small sample (cervical biopsy) of the tissue. Usually
several samples are taken. The samples are looked at under a microscope for
changes in the cells that may mean cancer may be present or is likely to
develop. If bleeding occurs, a special liquid (Monsel's) or silver nitrate swab
may be used on the biopsy area to stop the bleeding.

If a sample of tissue is needed from inside the opening of the
cervix (the endocervical canal), a test called endocervical curettage (ECC)
will be done. Since the endocervical canal cannot be seen by the colposcope, a
small sharp-edged tool called a curette is gently put into the endocervical
canal to take a sample. ECC takes less than a minute to do and may cause mild
cramping. An ECC is not done during pregnancy.

Colposcopy and a cervical biopsy usually take about 15
minutes.

How It Feels

You may feel some discomfort when the vaginal speculum is inserted.
You may feel a pinch and have some cramping if a biopsy sample is taken.

Risks

In rare cases, a cervical biopsy can cause an infection or
bleeding. Bleeding can usually be stopped by using a special liquid or swab on
the area.

After the test

If you have a biopsy, you may feel some soreness in your vagina for a day or two. Some
vaginal bleeding or discharge is normal for up to a week after a biopsy. The
discharge may be dark-colored if Monsel's solution was used. You can use a
sanitary pad for the bleeding. Do not douche, have sex, or use tampons for one
week, to allow time for your cervix to heal. Do not exercise for 1 day after
your colposcopy.

Follow any instructions your doctor gave you. Call your doctor if
you have:

Heavy vaginal bleeding (more than a normal
menstrual period).

A fever.

Belly
pain.

Bad-smelling vaginal discharge.

Results

Colposcopy is a way for your doctor to use a special magnifying
device to look at your
vulva,
vagina, and
cervix.

Your doctor will talk to you about what he or she sees at the time
of the colposcopy. Lab results from a
biopsy may take several days or more.

Colposcopy and cervical biopsy

Normal:

The vinegar or iodine does not show any areas of abnormal
tissue. The vagina and cervix look normal.

A biopsy sample does not show any abnormal
cells.

Abnormal:

The vinegar or iodine shows areas of abnormal tissue. Sores
or other problems, such as
genital warts or an infection, are found in or around
the vagina or cervix.

A biopsy sample shows abnormal cells. This may mean
cervical cancer is present or likely to develop.

What Affects the Test

Reasons you may not be able to have the colposcopy or why the
results may not be helpful include:

If you have sexual intercourse 24 hours before the colposcopy.

The use of douches, tampons, or vaginal creams
or medicines 24 hours before the colposcopy.

If you are having a
menstrual period at the time of the colposcopy.

If a vaginal or
cervical infection is present.

If you have gone through
menopause. Hormonal changes may make it hard to
see the cervical canal clearly.

What To Think About

Colposcopy is not usually used as a screening
test for women at high risk for cervical cancer. A Pap test is done for that
purpose. But a colposcopy gives you and your doctor more information if you have an abnormal result from a Pap test.

If a colposcopy and cervical biopsy are
normal, it is not likely that you have cell changes that can lead to cervical
cancer. But your doctor may still want you to have Pap tests more often for a period of time.

Another biopsy may be needed if a Pap test, colposcopy, and
cervical biopsy show different results.

Women with
human immunodeficiency virus (HIV) have a higher
chance of developing cervical cancer. A colposcopy is usually recommended for women
with HIV and an abnormal Pap test.

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